Provider Demographics
NPI:1073350849
Name:MEDUNA, BREE LYNN (LICSW)
Entity type:Individual
Prefix:
First Name:BREE
Middle Name:LYNN
Last Name:MEDUNA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:BREANNA
Other - Middle Name:LYNN
Other - Last Name:MEDUNA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:3000 AMES CROSSING RD STE 600
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-2570
Mailing Address - Country:US
Mailing Address - Phone:651-774-0011
Mailing Address - Fax:651-774-0606
Practice Address - Street 1:5555 BOONE AVE N
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:MN
Practice Address - Zip Code:55428-3636
Practice Address - Country:US
Practice Address - Phone:651-774-0011
Practice Address - Fax:651-774-0606
Is Sole Proprietor?:No
Enumeration Date:2024-07-10
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN205641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical